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Over the last four decades there has been extensive research into the links between diet and coronary heart disease. The most recent literature is reviewed in this position statement. The clinical and public health aspects of the National Heart Foundation's nutrition policy are based on this review. The key points are as follows: 1. Saturated fatty acids A high intake of saturated fatty acids is strongly associated with elevated serum cholesterol and LDL-cholesterol levels and increased risk of coronary heart disease. 2. The n-6 polyunsaturated fatty acids The n-6 polyunsaturated fatty acids (principally linoleic acid) lower serum cholesterol levels when substituted for saturated fats and probably have an independent cholesterol-lowering effect. 3. The n-3 polyunsaturated fatty acids (fish oils) The n-3 polyunsaturated fatty acids reduce serum triglyceride levels, decrease the tendency to thrombosis and may further reduce coronary risk through other mechanisms. 4. Monounsaturated fatty acids Monounsaturated fatty acids reduce serum cholesterol levels when substituted for saturated fatty acids. It is not clear whether this is an independent effect or simply the result of displacement of saturates. 5. Trans fatty acids Trans fatty acids may increase serum cholesterol levels and can be reckoned to be equivalent to saturated fatty acids. 6. Total fat Total fat intake, independent of fatty acid type, is not strongly associated with coronary heart disease but may contribute to obesity. Associations between total fat intake and coronary heart disease are primarily mediated through the saturated fatty acid component. 7. Dietary cholesterol Dietary cholesterol increases serum cholesterol levels in some people and may increase risk of coronary heart disease. 8. Alcohol A high intake of alcohol increases blood pressure and serum triglyceride levels and increases mortality from cardiovascular disease. Light alcohol consumption reduces the risk of coronary heart disease. 9. Sugar The consumption of sugar is not associated with coronary heart disease. 10. Sodium and potassium High salt intake is related to hypertension especially in the subset of "salt-sensitive" people. Potassium intake may be inversely related to hypertension. 11. Overweight and obesity Abdominal obesity increases the risk of coronary heart disease probably by adversely influencing conventional risk factors. 12. Vegetarianism A high intake of plant foods reduces the risk of coronary heart disease through several mechanisms, including lowering serum cholesterol and blood pressure levels.
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PMID:Diet and coronary heart disease. The National Heart Foundation of Australia. 163 Mar 69

The electrocardiograms of 780 seamen and deep-sea fishermen, aged over 40 or of at least a 10 years' service at sea, randomly selected, were evaluated according to the Minnesota Code 1982 criteria. Out of them, 70.3% were found normal, 29.7% were not. In the latter group pathological Q or QS waves were noted in 1.4% Defective repolarization of the ventricle myocardium in the fourth and fifth category were observed in 4.5%. Atrio-ventricular first degree block was revealed in 1.4%, intraventricular conduction defects totalled 3.8%. Heart action disorders in the form of frequent ventricular and junctional beats were diagnosed in 2.3%. Arterial hypertension in terms of WHO criteria was observed in 9.4% subjects. Overweight and obesity affected 8.3% patients under investigation. The rate of deviations in the electrocardiograms subjected to the evaluation with the code do not diverge significantly from the data obtained from the studies on industrial workers in Poland.
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PMID:Minnesota Code 1982 based evaluation of electrocardiograms in population of seamen and deep-sea fishermen (of long occupational experience at sea). 184 49

Overweight and obesity may develop in individuals with genetically determined low resting energy expenditure. Drugs are among the recognised precipitating factors. The obesity promoting impact of beta-blockers is, however, less well known. Resting energy expenditure, and thermogenesis induced by stimuli such as meals, cold and heat exposure, stress and anxiety, have a facultative component mediated by the sympathoadrenal system through catecholamines working on beta-adrenoceptors. Treatment with beta-blockers reduces the facultative thermogenesis by 50-100 kcal/d, which corresponds to the weight gain of 2-5 kg/year reported in clinical trials. Treatment with beta-blockers also results in insulin resistance, which may aggravate existing diabetes and elicit diabetes in predisposed patients. Overweight and obesity are frequently complicated with hypertension and angina pectoris, which are often treated with beta-blockers. Obesity is associated with a defective sympathetic activity, and treatment with beta-blockers may further reduce facultative thermogenesis and promote weight gain. The consequence may be aggravation of hypertension, insulin resistance and other atherogenic factors. The causal therapy of android overweight and obesity complicated with diabetes or hypertension is a sufficient weight loss. If pharmacological treatment is inevitable, combined treatment with diuretics and ACE-inhibitors are most appropriate.
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PMID:[Obesity and diabetes as side-effects of beta-blockers]. 197 28

Overweight and obesity have been examined in 7735 middle-aged men in 24 British towns. Half the men exceeded the body mass index (BMI) range associated with minimum mortality (20-25 kg/m2). Social class differences in BMI were marked and obesity was more marked in manual workers. The association of reduced BMI with cigarette smoking and of increased BMI with stopping smoking was most clearly seen in manual workers. With increasing alcohol intake, BMI increased progressively, but the effect in the heaviest drinkers was probably diminished by concurrent heavy smoking. Mean BMI decreased with increasing levels of physical activity. There was considerable variation in the rate of obesity between the towns, from 11 to 28 per cent, determined to some extent by social class. Positive associations were observed between BMI and the presence of ischaemic heart disease, high blood pressure, gout, arthritis and gallbladder disease but not with diabetes mellitus. Peptic ulcer was inversely related to BMI and bronchitis showed a curvilinear relationship. For these men, overweight or obesity is virtually 'normal', and a considerable health education effort will be needed to produce a leaner, healthier society.
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PMID:Overweight and obesity in middle-aged British men. 338 26

Overweight and obesity are associated with several important diseases, including diabetes, cardio- and cerebrovascular diseases, digestive disorders and cancer. We decided, therefore, to present estimates of the prevalence of overweight and obesity in the general Italian population. The prevalence of overweight and obesity in Italy was evaluated using data from the 1990-91 Italian National Health Survey. 25,818 households were surveyed, representing the whole Italian population. A sample of 24,602 males and 26,090 females aged 15 or over was randomly selected, within strata of geographical area, size of municipality and size of household, in order to be fully representative. Quetelet's index was considered as a measure of body mass index, on the basis of self reported height and weight, and was a priori divided into four levels: underweight (< 20 kgm-2), normal weight (20 to 24.9 kgm-2), overweight (25 to 29.9 kgm-2), and obese (> or = 30 kgm-2). In the overall national sample, 11.0% of subjects were underweight (4.4% males, 12.2% females), 50.8% normal weight (49.4% males, 52.2% females), 31.6% overweight (39.2% males, 24.5% females), and 6.5% obese (7.0% males, 6.1% females). The prevalence of overweight and obesity was higher in middle age and in the South of the country, and was directly related to history of diabetes, hypertension, heart diseases, gallbladder disease and chronic respiratory disorders. These data quantify the importance of overweight and obesity as a public health issue in the general Italian population.
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PMID:Overweight and obesity in Italy, 1990-91. 786 61

Overweight and obesity are generally considered to have a negative impact on longevity because of their association with many diseases, including hypertension, diabetes, coronary artery disease, osteoarthritis, and certain types of cancer. Nevertheless, some authors, notably Ancel Keys, have concluded that being overweight improves one's chances for longevity. I studied 122 consecutive patients who had comprehensive geriatric assessment with regard to their body mass index, responses to Wolinsky's Nutritional Risk Index, and serum albumin levels. There was a high prevalence of overweight (60% of men and 45.6% of women). This fact, coupled with the observed low prevalence of underweight subjects, tends to support Keys' statement concerning the benefit of being overweight. However, the relative absence of significant obesity supports the impression that significantly obesity reduces prospects for longevity. Although serum albumin measurements were obtained for only 38 subjects, the fact that the value was low in only one instance--in the case of a person who was seriously ill--suggests that obtaining routine serum albumin measurements in ambulatory, community-dwelling elderly people is not cost-effective.
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PMID:Assessment of nutritional status and obesity in elderly patients as seen in general medical practice. 836 44

The aim of this study was to estimate the coexistence of risk factors for coronary heart disease (CHD) in hyperlipidemic patients. Studies were performed in 1002 (601 women, 401 men) subjects who referred to our outpatient clinic among 12 months. Hypercholesterolemia was the predominant lipid disorder found in 66% of patients, mixed hyperlipidemia in 31.8%, and hypertriglyceridemia only in 2.2%. Overweight and obesity remain a major health burden among our patients: BMI > or = 25 was observed in 66%. Hypertension was recognized in 37.5% of subjects, and diabetes mellitus in 11.2%, 17% were long-term smokers. Familial aggregation of hyperlipidemia was observed in 15.7% of subjects, and more than 44% had a positive family history of cardiovascular disease. Low HDL cholesterol levels (< 35 mg/dl) were seen frequently in men (24.7%) and rare in women (7%). Lp(a) excess (> or = 30 mg/dl) was observed in 12% of patients. Myocardial infarction (MI) had already 11.7% subjects (7% women, 18.7% men). In these patients CHD risk factors were observed more frequently. The higher apo B and Lp(a) levels and lower HDL cholesterol levels were recognized in the patients who suffered from MI. More than 83% of our hyperlipidemic patients had coexistence CHD risk factors. The multiple coexisting risk factors cause the high risk for CHD and they require intensive correction.
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PMID:[Risk factors for coronary heart disease in 1002 patients with hyperlipidemia]. 941 22

Physicians are reluctant to treat obesity despite the rapid increase in its prevalence in the UK and its associated health problems such as diabetes, coronary heart disease and hypertension. Overweight and obesity are chronic conditions that require long-term treatment. Any therapeutic programme should combine dietary restriction with physical activity and alterations to lifestyle. The use of pharmacological treatment as an adjunct to conventional treatment modalities is justified in certain circumstances. The criteria applied for the prescription of an anti-obesity drug should be comparable to that applied to the treatment of other relapsing disorders. The objective of the Royal College of Physicians' new report, Clinical management of overweight and obese patients with particular reference to the use of drugs, is the provision of such necessary guidance. Based on evidence from clinical trials, the recommendations of the report utilise a 12-week goal (outside a drug trial) of 5% body weight loss from the start of drug treatment. Failure to achieve this goal is an indication for stopping drug therapy. Safety and efficacy demand appropriate use of anti-obesity drugs in a supervised setting with clinicians weighing up likely medical benefit against possible risks.
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PMID:Prescribing for obesity. Comment on the Royal College of Physicians' Working Party report on clinical management of overweight and obese patients with particular reference to drugs. 1019 66

Overweight and obesity represent a rapidly growing threat to the health of populations in an increasing number of countries. Indeed they are now so common that they are replacing more traditional problems such as undernutrition and infectious diseases as the most significant causes of ill-health. Obesity comorbidities include coronary heart disease, hypertension and stroke, certain types of cancer, non-insulin-dependent diabetes mellitus, gallbladder disease, dyslipidaemia, osteoarthritis and gout, and pulmonary diseases, including sleep apnoea. In addition, the obese suffer from social bias, prejudice and discrimination, on the part not only of the general public but also of health professionals, and this may make them reluctant to seek medical assistance. WHO therefore convened a Consultation on obesity to review current epidemiological information, contributing factors and associated consequences, and this report presents its conclusions and recommendations. In particular, the Consultation considered the system for classifying overweight and obesity based on the body mass index, and concluded that a coherent system is now available and should be adopted internationally. The Consultation also concluded that the fundamental causes of the obesity epidemic are sedentary lifestyles and high-fat energy-dense diets, both resulting from the profound changes taking place in society and the behavioural patterns of communities as a consequence of increased urbanization and industrialization and the disappearance of traditional lifestyles. A reduction in fat intake to around 20-25% of energy is necessary to minimize energy imbalance and weight gain in sedentary individuals. While there is strong evidence that certain genes have an influence on body mass and body fat, most do not qualify as necessary genes, i.e. genes that cause obesity whenever two copies of the defective allele are present; it is likely to be many years before the results of genetic research can be applied to the problem. Methods for the treatment of obesity are described, including dietary management, physical activity and exercise, and antiobesity drugs, with gastrointestinal surgery being reserved for extreme cases.
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PMID:Obesity: preventing and managing the global epidemic. Report of a WHO consultation. 1123 59

Overweight and obesity are recognised as responsible for an increase in vascular risk and in excess mortality due to cardio-vascular diseases. This is especially true in presence of increased visceral (central) fat distribution, a key factor for insulin-resistance, the main component of the metabolic syndrome X. Cardio-vascular risk in overweight and obese subjects appears strongly correlated with the common risk factors, more frequently present in these patients: type 2 diabetes, hypertension, lipid abnormalities. Weight reduction improves all risk factors and decreases the patient's global vascular risk. The improvement in the various risk factors is significant with a moderate weight loss (10% of the initial weight). Weight reduction should been obtained always with nutritional-hygienic means (physical activity, weight-reducing diet...) maintained for several months. Only when these approaches appear to be insufficient, the need for an associated pharmacological treatment has to be considered. Amongst the weight-reducing drugs currently available or close to be, orlistat has demonstrated its interest in the glycemic control of type 2 diabetic patients, and its favourable effect in hypertensive patients. Available clinical studies have clearly shown the more marked effect of orlistat in comparison to placebo in reducing the various risk factors. So far, few studies have been conducted to assess the effects of the specific drug therapy on the control of metabolic abnormalities and risk factors in overweight or obese patients, except in type 2 diabetic patients for whom, most of the oral anti-diabetic agents have been tested in overweight or obese diabetic population.
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PMID:[Obesity and cardiovascular risk]. 1178 68


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